Laois TDs were given less than six minutes to raise the future of Portlaoise hospital in the Dáil this week and the Minister for Health was not present to answer their questions.
Fianna Fáil TD Sean Fleming and Sinn Féin's Brian Stanley were given two minutes each to raise the issue and a further minute each to discuss the issue which was the subject of a major report from the health wathdog HIQA.
Minister of State, Deputy Finian McGrath, repeated previous answers on Portlaoise but agreed with points made by the TDs that there should be consultation locally before change and that the Minister for Health Simon Harris should meet local stakeholders such as the family doctors.
Deputy Fleming thanked Minister McGrath for standing in for the Fine Gael Minister but he said Minister Harris should be present.
"I am saying clearly on the record of the House that I need to speak to the Minister, Deputy Harris, directly on this issue. Any plans by the Department of Health will go nowhere until such time as we have proper consultation with the Minister on the matter.
"The recent HIQA report contained nothing that was a surprise to me. Essentially, the report says that progress is being made in the maternity unit at Portlaoise hospital but that investment is required in the medical and intensive care unit in order to bring them up to standard. This has been known for quite some time but the HSE has not yet taken action. It should get a move on and do so immediately.
"The main issue highlighted in the HIQA report relates to the difficulties in the accident and emergency department. The problem is that there are a large number of patients - over 36,000 - attending the emergency department in Portlaoise each year. There is not the appropriate number of consultant staff to deal with these patients and neither is there a named emergency consultant available on 24 hours a day, seven days a week.
"The answer is very simple. We have to take the necessary steps to ensure that we have enough consultants and medical and nursing staff available in the emergency department at Portlaoise hospital to deal with the patients who arrive there. Remarkably, the HSE's response to this problem is to consider cutting the number of hours the emergency department is open, thereby reducing the numbers attending to match the number of staff it wants to employ. This attitude by the HSE is totally wrong and if it represents the ethos of the HSE at national level, it has to be fundamentally changed.
Deputy Stanley said the future of the hospital is at stake and he wanted to know if the HIQA report would be used to downgrade.
"The issue arising from the HIQA report is very important and the question for the Independent-Fine Gael Government is whether it will use it as an excuse to downgrade services and close the hospital or whether it will use the report to improve services.
"The HIQA report said the hospital was at a critical juncture and that, to function as a model 3 hospital, it must be adequately and sustainably resourced. It said that services were being sustained through a reliance on agency staff which is costly and not good practice from the perspective of service sustainability. It stated that the ongoing reliance on agency staff had significant financial implications for the hospital," he said.
The Sinn Féin TD said none of the past four Governments has put forward a clear, long-term strategic plan for Portlaoise. HIQA said the remaining risks will only be fully addressed through the formulation and enactment of a clear strategic plan.
"Last year, almost 37,000 patients attended the emergency department in Portlaoise. There is a problem with capacity across the State and every Deputy in this House knows it. If the emergency department in Portlaoise is closed, where can patients be sent? They cannot be sent to Naas and they cannot be sent to Tallaght or Tullamore because they are already out the door. The report, which is now in the Government's hands, was headed up by Dr. Susan O'Reilly . She is determined to plough on," he said.
Minister of State McGrath welcomed this HIQA report, which he said found that significant progress had been made at the hospital in relation to governance, patient safety and quality, and shows how much services have improved for the women using maternity services at the hospital.
He said there has been considerable investment in Portlaoise in recent years. Hospital funding has increased by 15% since 2012 and staffing levels have risen by 18%. Additional funding is to be provided to facilitate the opening of the new medical assessment unit at Portlaoise in 2017.
"The most important issue in relation to any changes at Portlaoise hospital is that patient safety and outcomes must come first. Any changes to services at Portlaoise, once approved, will be undertaken in a planned and orderly manner to further improve services for patients at the hospital and will take account of existing patient flows and demands in other hospitals, as well as the need to develop particular services at Portlaoise in the context of the overall service configuration in the Dublin Midlands Hospital Group," he said.
Minister McGrath said it is important that we also acknowledge the fact that since 2012, there has been an 18% increase in staffing levels across maternity services, paediatric medicine and the emergency services, and a 15% increase in funding in 2016
"However, there remain real issues of concern. I am aware of them in my local hospital, Beaumont Hospital. We have difficulty recruiting staff and we then find ourselves spending extra money on emergency agency staff. I take that point because I have experienced this in the disability sector.
"Deputy Brian Stanley mentioned the 69 medical professionals who have been lobbying local Deputies. This is very important. Their voices must be heard. I will absolutely bring Deputy Stanley's concerns to the Minister's attention.
"To follow up on Deputy Sean Fleming's point, the Minister should meet him to discuss the issue raised," concluded the Minister of State.
During the debate on Wednesday, Acting Chairman, Eugene Murphy imposed strict time limits on how long the TDs could speak on the hospital. They were given six minutes in total.